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Essential Reading for Smart Spending

My Hospital Guide 2013

Essential Reading for Smart Spending
My Hospital Guide 2013
  • Commissioning
    Measuring commissioning in the NHS
  • Drug and Alcohol Admissions
    Analysing drug and alcohol admissions in the NHS
  • Weekend Care
    Analysing weekend care in the NHS
  • Mortality
    Measuring mortality in the NHS
Join the conversation

@drfosterintel #dfhg2013

The Report
Dr Foster Hospital Guide 2013

Introduction

This year’s Hospital Guide – in both digital and printed formats - is delivered using posters. Why posters? In the era of electronic media, using one of the oldest forms of communication known to man may seem perverse. But there are good reasons why sticking information up on walls has remained popular, from ancient royal proclamations to modern marketing campaigns.

One of the most obvious features of posters is that they are, by their nature, public and transparent. Books and websites are made to be read individually and digested in private. Posters – digitally and in print - are about sharing information and messages.

Read more

Put care into spending & spending into care

Just looking for the data?

Setting the scene

Clinical Commissioning Groups have only been in existence since April 2013, but to commission care appropriately in the future for their patients, they need to understand what has happened in the past.

We have mapped patient activity for the last ten years as if CCGs had existed to examine the decisions that have been made in the past on behalf of their patients. This includes focussing on operations that might not have been necessary, emergency visits to hospital, routine surgery and decisions on where patients can receive the safest care for certain conditions.

Findings for 2009/10–2012/13

3%

Rise in overall emergency admissions to hospital

8%

Rise in avoidable emergency admissions

9%

Drop in less effective procedures carried out (e.g. tonsillectomies, knee wash-outs and injections for back pain)

More effective operations (e.g. hip replacements, knee replacements and cataract surgery) have remained stable

Long-term conditions and frail elderly

(% change relative to 2003/4)

74%

Rise in emergency diabetes admissions

15%

Rise in emergency COPD admissions

149%

Rise in emergency urinary tract infections admissions for over-75s

Emergency Admissions

In the past three years avoidable emergency admissions have risen faster than all emergency admissions.

Avoidable emergency admissions

All emergency admissions

2005/06 Labour party re-elected and NHS funding squeeze
2010/11 Coalition governement elected and savings challenge issued
2012/13 NHS reforms enacted and CCGs created

Planned Procedures

Less effective procedures have fallen more than effective procedures.

Hip and knee replacement and cataract operations (effective procedures)

Less effective procedures (e.g. injections for back pain)

Percentage change compared to the previous year

12%

10%

8%

6%

4%

2%

0%

-2%

-4%

2007/8

2008/9

2009/10

2010/11

2011/12

2012/13

Dr Foster’s Findings

“Spending on less effective operations has fallen whereas spending on more effective operations has continued to rise, albeit more slowly. There has been no reduction in admissions for conditions treatable in the community. However, there are some parts of the country that have been more successful in reducing spending on these preventable admissions to hospital.”

Get Help For Your 44-Year-Old  Drink and Drug Issue

Get Help For Your 44-Year-Old  Drink and Drug Issue

In the past three years

500,000 people

have been hospitalised because of drug and alcohol abuse

Setting the scene

Public policy on drug and alcohol misuse has emphasised the dangers of binge drinking among the young. It has also warned against the dangers of long term drinking above recommended levels due to the impact on health. However, serious alcohol and drug dependency among the middle aged has been has not been given the same attention. It is this, however, which is placing one of the biggest burdens on our health system in terms of use of hospital beds.

cent24

Overall, nearly one in ten admissions for emergency care are due to adults with a drug or alcohol problem

415,131

Drug and alcohol-related emergency admissions in 2012/13

533,302

Patients admitted with a known drug or alcohol problem over the past three years

cent36

of drug and alcohol patients were from the poorest neighbourhoods

This is a middle- 
 aged issue

People with a drug or alcohol problem account for 19% of all emergency admissions among 40–44 year olds

All drug and alcohol related emergency admissions by age

Age

0

20

40

60

80

100

% All Emergency Admissions

The average age 
 is rising

Ten years ago, the peak age for this type of hospital treatment was younger than it is today.

Long Term Drug and Alcohol Problems

Age

2012/13

2006/7

2002/3

Includes patients in each year from 2002/3 to 2012/13 who had at least one admission relating to drug or long-term alcohol abuse

Binge Drinking

Age

2012/13

2006/7

2002/3

Includes patients who had exactly one emergency admission for acute alcohol intoxication between 2002/3 and 2012/13 and no admission relating to drug or long-term alcohol abuse in that period

View from the expert

Lord Victor Adebowale

Chief executive,
Turning Point
Turning Point - Turning Lives Around
“Dr Foster’s figures show that substance misuse is a major health challenge. The increase in hospital admissions of middle-aged people dictates the need for changes across the health and care system including how we respond to people in crisis. Over 20% of admissions due to people with a drug or alcohol problem do not have a recorded GP. This is worrying, and requires a far more integrated approach to substance misuse across primary and secondary care. We need to respond earlier to the unique social impact of addiction experienced by this group in order to reduce the likelihood of intergenerational problems escalating. The challenge set to the health service by these figures is to consider the costs associated with substance misuse and how investment across health, social care and public health initiatives can address the barriers currently preventing people getting the support they need.”

Your mortality rate is your pulse, keep your finger on it

Just looking for the data?

2012/13 In Numbers

237,100 patients died in hospital in 2012/13

4,400 more than 2011/12

5,300 fewer than 2010/11

the second lowest number for ten years

Risk adjustment

The first thing we need to know to create a mortality measure is the reason or diagnosis for which the patient was admitted to hospital.

All hospitals treat different patients; some have older patients and some have patients more likely to have a serious condition.

In 2012/13 we have included 12 different factors in our main way of measuring deaths in hospital (which we call the Hospital Standardised Mortality Ratio or HSMR)

Highest Crude Mortality

53%

Cardiac arrest and ventricular fibrillation

Lowest Crude Mortality

0.2%

Abdominal pain

Most Important Factors

Age

Underlying Health Conditions (Comorbidities)

Planned/Unplanned Admissions

Average C-Statistic

0.71

0.65

0.63

HSMR C-Statistic

0.85

C-Statistic?

The C-statistic tells you the degree to which each factor predicts the death of the patient. A statistic of 1 for age would mean that age completely determined whether or not the patient died. A statistic of 0.5 would mean there was no connection between age and the likelihood of death.

What are the different measures of mortality?

There are many ways to measure mortality. It is important to consider the following questions:

How many patients died from the groups of diagnoses where 80% of deaths occur? Measured using the HSMR.

How many patients died in each hospital site and what happens if we remove patients in community or longer-term care? Measured using our site-level HSMR and the HSMR excluding community care.

What happens to patients at the end of their life? Tracked by looking at palliative care rates.

What happens if we include patients who died soon (within 30 days) after leaving hospital? Measured using the Summary Hospital-level Mortality Indicator (SHMI).

How many patients died after an operation possibly went wrong? Measured using our Deaths after Surgery indicator.

How many patients died who had a condition with a low immediate risk of death? Measured using our Deaths in Low-risk Conditions indicator.

Interrogating the information

What happens if we:

Exclude community beds

One trust improves its banding

Look at individual hospitals within a hospital trust

10 trusts have one or more hospitals with a rate higher than the overall trust

14 trusts have one or more hospitals with a lower rate than the overall trust

Examine pallative care rates

Rates of palliative care vary from 1.2% to 43.2%

Adjusting for rates of palliative care makes a significant difference to mortality (as measured by the SHMI) for 29 trusts

Percentage of deaths in hospital where the patient has been identified as receiving palliative care

43.2% (Highest Palliative Care Rate)

East and North Hertfordshire NHS Trust

1.2% (Lowest Palliative Care Rate)

Taunton and Somerset NHS Foundation Trust

Strengthen your Weakend

Just looking for the data?

Setting the scene

Dr Foster has been publishing information about mortality rates for two years in our annual Hospital Guide. Although some hospitals have taken steps to improve the situation, we remain concerned that the quality of care has marked differences on weekdays when compared with the weekend.

Mortality

Emergency overall mortality

20%
Higher on weekends

Mortality for patients who had routine surgery

24%
Higher on Fridays
Scans

Emergency MRI scans on the day of admission

42%
Lower on weekends

Emergency endoscopies on the day of admission

40%
Lower on weekends
Operations

Repairing fractures on the day of admission

10%
Lower on weekends

Waiting more than two days for repair of broken hip

24%
Higher on weekends
Readmissions

Patients returning to hospital after first being admitted on a weekend

3.9%
Higher

A Seniority Issue?

Junior doctors are more likely than senior ones to have concerns about care at weekends

68% of doctors surveyed by Dr Foster and Doctors.net.uk believed that patients admitted at weekends receive poorer quality of care than patients admitted on weekdays at the hospital they worked in.

Percentage of doctors who think that patients admitted at the weekend have poorer quality of care than patients admitted on weekdays

66% consultants
76% middle-grade doctors
74% junior doctors
Doctors.net.uk

Introduction to The Report

Roger Taylor
Roger Taylor

This year’s Hospital Guide – in both digital and printed formats – is delivered using posters. Why posters? In the era of electronic media, using one of the oldest forms of communication known to man may seem perverse. But there are good reasons why sticking information up on walls has remained popular, from ancient royal proclamations to modern marketing campaigns.

One of the most obvious features of posters is that they are, by their nature, public and transparent. Books and websites are made to be read individually and digested in private. Posters – digitally and in print – are about sharing information and messages.

Another reason is that they are concise. More than ever, in healthcare, we need to learn to boil information down into clear conclusions. We need to work hard to see the wood for the trees.

When Dr Foster first started publishing this guide more than a decade ago, we were addressing the lack of information about quality of healthcare. It was not just that the public had little or no information. Nobody inside or outside the NHS had the information they needed to tell good care from bad.

Today, for much of the NHS the problem is no longer a lack of information, it is a surfeit.

NHS hospitals are awash with data. Along with the information that Dr Foster provides, there are national reporting systems; national clinical audits; feedback from NHS Choices, from national patient surveys and from staff surveys; reports from patient safety monitoring programmes and from infection control monitoring… to name just some of the most obvious sources. Within the hospital there is an ever increasing pool of information drawn from internal information systems and electronic records. Each source is capable of providing information about different diagnoses, different patient groups as well as trends over time.

Put it all together and those running hospitals or commissioning NHS services have available to them tens of thousands of data points which relate to the cost and the quality of the service they provide. How does the board of a hospital make any decision comfortable in the knowledge that it has adequately assessed the available information?

The complexity leads some people to despair of the process. Observing that the data is of variable reliability, sometimes contradictory and never simple to interpret, they conclude that nothing can be proven beyond doubt and wash their hands of the whole exercise.

That is a cop out. Decisions about spending and care will be made one way or the other. We have seen too often the consequence of bad decisions – decisions made in the face of strong clues in the data that the actions being taken were causing harm to patients and wasting resources. The problem may be hard but it cannot be ignored or avoided.

Doctors understand this dilemma. The art and science of diagnosis requires the assessment of complex, sometimes contradictory clues to reach a view on the best way to treat the patient. Sometimes it is simple. Sometimes the only option is to proceed with treatment On the basis of uncertain conclusions on the grounds that doing nothing is likely to be worse.

The management and administration of our health services has yet to achieve an equivalent degree of skill in the way it uses information to diagnose the problems of our health system and identify the most appropriate remedies.

This may explain one of the most troubling findings in this year’s guide. This year we set out the findings of a survey of NHS hospital doctors carried out by Doctors.net.uk. Most doctors responding to the survey did not agree that their hospital always acted on concerns raised by staff. One in four expressed no confidence in the management of their hospital.

Less surprising was the finding from the survey that most doctors believe patients get a worse standard of care if they come dr foster hospital guide 2013 into hospital at a weekend. This year we have returned to the subject of hospital care at weekends and looked at a wide range of measures – mortality rates, readmission rates, access to diagnostic tests and the length of time that urgent patients wait for surgery. On every measure we looked at, the position for patients admitted at weekends was worse than for patients admitted during the week.

Each data point on its own is open to interpretation. Every number we publish is affected by confounding factors and surrounded with statistical uncertainty. No single metric could ever safely lead to a firm conclusion.

But when all the data points in one direction – when every piece of information is repeating a consistent message – it is important to draw that conclusion out clearly and share it. That is why we have used posters.

Whether it is the impact of drugs and alcohol on our health and on the NHS, the variation in mortality rates between hospitals or the way in which financial constraints are affecting services, our aim has been to draw out the important messages and provide a mechanism to communicate them.

The Hospital Guide is sent to every hospital and commissioning chief executive in England. We hope that within it they will find at least one poster that they would like to put up in their office or in the corridors of their hospital.

This does not mean, of course, that we are giving up on digital media. Here at myhospitalguide.com you can interrogate all the data in detail, link to the many examples of excellent practice highlighted in the guide, and share the report and posters with your own contacts to stimulate discussion and change. We hope that you will do that!

Roger Taylor
Co-founder, Dr Foster Intelligence

The Report

This year’s Hospital Guide – in both digital and printed formats – is delivered using posters. Why posters? In the era of electronic media, using one of the oldest forms of communication known to man may seem perverse. But there are good reasons why sticking information up on walls has remained popular, from ancient royal proclamations to modern marketing campaigns.

When Dr Foster first started publishing this guide more than a decade ago, we were addressing the lack of information about quality of healthcare. It was not just that the public had little or no information. Nobody inside or outside the NHS had the information they needed to tell good care from bad.

Today, for much of the NHS the problem is no longer a lack of information, it is a surfeit.

The Hospital Guide is sent to every hospital and commissioning chief executive in England. We hope that within it they will find at least one poster that they would like to put up in their office or in the corridors of their hospital.

To See The Full Report Download The PDF
The Data

We weren’t able to auto-detect your location.
Enter a postcode or select a trust/commissioning area from the list below.

Postcode

Your nearest trust

Select a trust
  • Aintree University Hospital NHS Foundation Trust
  • Airedale NHS Foundation Trust
  • Ashford and St Peter’s Hospitals NHS Foundation Trust
  • Barking, Havering and Redbridge University Hospitals NHS Trust
  • Barnet and Chase Farm Hospitals NHS Trust
  • Barnsley Hospital NHS Foundation Trust
  • Barts Health NHS Trust
  • Basildon and Thurrock University Hospitals NHS Foundation Trust
  • Bedford Hospital NHS Trust
  • Blackpool Teaching Hospitals NHS Foundation Trust
  • Bolton NHS Foundation Trust
  • Bradford Teaching Hospitals NHS Foundation Trust
  • Brighton and Sussex University Hospitals NHS Trust
  • Buckinghamshire Healthcare NHS Trust
  • Burton Hospitals NHS Foundation Trust
  • Calderdale and Huddersfield NHS Foundation Trust
  • Cambridge University Hospitals NHS Foundation Trust
  • Central Manchester University Hospitals NHS Foundation Trust
  • Chelsea and Westminster Hospital NHS Foundation Trust
  • Chesterfield Royal Hospital NHS Foundation Trust
  • City Hospitals Sunderland NHS Foundation Trust
  • Colchester Hospital University NHS Foundation Trust
  • Countess Of Chester Hospital NHS Foundation Trust
  • County Durham and Darlington NHS Foundation Trust
  • Croydon Health Services NHS Trust
  • Dartford and Gravesham NHS Trust
  • Derby Hospitals NHS Foundation Trust
  • Doncaster and Bassetlaw Hospitals NHS Foundation Trust
  • Dorset County Hospital NHS Foundation Trust
  • Ealing Hospital NHS Trust
  • East Cheshire NHS Trust
  • East Kent Hospitals University NHS Foundation Trust
  • East Lancashire Hospitals NHS Trust
  • East Sussex Healthcare NHS Trust
  • East and North Hertfordshire NHS Trust
  • Epsom and St Helier University Hospitals NHS Trust
  • Frimley Park Hospital NHS Foundation Trust
  • Gateshead Health NHS Foundation Trust
  • George Eliot Hospital NHS Trust
  • Gloucestershire Hospitals NHS Foundation Trust
  • Great Western Hospitals NHS Foundation Trust
  • Guy’s and St Thomas’ NHS Foundation Trust
  • Hampshire Hospitals NHS Foundation Trust
  • Harrogate and District NHS Foundation Trust
  • Heart Of England NHS Foundation Trust
  • Heatherwood and Wexham Park Hospitals NHS Foundation Trust
  • Hinchingbrooke Health Care NHS Trust
  • Homerton University Hospital NHS Foundation Trust
  • Hull and East Yorkshire Hospitals NHS Trust
  • Imperial College Healthcare NHS Trust
  • Ipswich Hospital NHS Trust
  • Isle Of Wight NHS Trust
  • James Paget University Hospitals NHS Foundation Trust
  • Kettering General Hospital NHS Foundation Trust
  • Kingston Hospital NHS Foundation Trust
  • King’s College Hospital NHS Foundation Trust
  • Lancashire Teaching Hospitals NHS Foundation Trust
  • Leeds Teaching Hospitals NHS Trust
  • Lewisham Healthcare NHS Trust
  • Luton and Dunstable Hospital NHS Foundation Trust
  • Maidstone and Tunbridge Wells NHS Trust
  • Medway NHS Foundation Trust
  • Mid Cheshire Hospitals NHS Foundation Trust
  • Mid Essex Hospital Services NHS Trust
  • Mid Staffordshire NHS Foundation Trust
  • Mid Yorkshire Hospitals NHS Trust
  • Milton Keynes Hospital NHS Foundation Trust
  • Norfolk and Norwich University Hospitals NHS Foundation Trust
  • North Bristol NHS Trust
  • North Cumbria University Hospitals NHS Trust
  • North Middlesex University Hospital NHS Trust
  • North Tees and Hartlepool NHS Foundation Trust
  • North West London Hospitals NHS Trust
  • Northampton General Hospital NHS Trust
  • Northern Devon Healthcare NHS Trust
  • Northern Lincolnshire and Goole Hospitals NHS Foundation Trust
  • Northumbria Healthcare NHS Foundation Trust
  • Nottingham University Hospitals NHS Trust
  • Oxford University Hospitals NHS Trust
  • Pennine Acute Hospitals NHS Trust
  • Peterborough and Stamford Hospitals NHS Foundation Trust
  • Plymouth Hospitals NHS Trust
  • Poole Hospital NHS Foundation Trust
  • Portsmouth Hospitals NHS Trust
  • Royal Berkshire NHS Foundation Trust
  • Royal Cornwall Hospitals NHS Trust
  • Royal Devon and Exeter NHS Foundation Trust
  • Royal Free London NHS Foundation Trust
  • Royal Liverpool and Broadgreen University Hospitals NHS Trust
  • Royal Surrey County Hospital NHS Foundation Trust
  • Royal United Hospital Bath NHS Trust
  • Salford Royal NHS Foundation Trust
  • Salisbury NHS Foundation Trust
  • Sandwell and West Birmingham Hospitals NHS Trust
  • Sheffield Teaching Hospitals NHS Foundation Trust
  • Sherwood Forest Hospitals NHS Foundation Trust
  • Shrewsbury and Telford Hospital NHS Trust
  • South Devon Healthcare NHS Foundation Trust
  • South London Healthcare NHS Trust
  • South Tees Hospitals NHS Foundation Trust
  • South Tyneside NHS Foundation Trust
  • South Warwickshire NHS Foundation Trust
  • Southend University Hospital NHS Foundation Trust
  • Southport and Ormskirk Hospital NHS Trust
  • St George’s Healthcare NHS Trust
  • St Helens and Knowsley Hospitals NHS Trust
  • Stockport NHS Foundation Trust
  • Surrey and Sussex Healthcare NHS Trust
  • Tameside Hospital NHS Foundation Trust
  • Taunton and Somerset NHS Foundation Trust
  • The Dudley Group NHS Foundation Trust
  • The Hillingdon Hospitals NHS Foundation Trust
  • The Newcastle Upon Tyne Hospitals NHS Foundation Trust
  • The Princess Alexandra Hospital NHS Trust
  • The Queen Elizabeth Hospital, King’s Lynn, NHS Foundation Trust
  • The Rotherham NHS Foundation Trust
  • The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust
  • The Royal Wolverhampton NHS Trust
  • The Whittington Hospital NHS Trust
  • United Lincolnshire Hospitals NHS Trust
  • University College London Hospitals NHS Foundation Trust
  • University Hospital Of North Staffordshire NHS Trust
  • University Hospital Of South Manchester NHS Foundation Trust
  • University Hospital Southampton NHS Foundation Trust
  • University Hospitals Birmingham NHS Foundation Trust
  • University Hospitals Bristol NHS Foundation Trust
  • University Hospitals Coventry and Warwickshire NHS Trust
  • University Hospitals Of Leicester NHS Trust
  • University Hospitals Of Morecambe Bay NHS Foundation Trust
  • Walsall Healthcare NHS Trust
  • Warrington and Halton Hospitals NHS Foundation Trust
  • West Hertfordshire Hospitals NHS Trust
  • West Middlesex University Hospital NHS Trust
  • West Suffolk NHS Foundation Trust
  • Western Sussex Hospitals NHS Foundation Trust
  • Weston Area Health NHS Trust
  • Wirral University Teaching Hospital NHS Foundation Trust
  • Worcestershire Acute Hospitals NHS Trust
  • Wrightington, Wigan and Leigh NHS Foundation Trust
  • Wye Valley NHS Trust
  • Yeovil District Hospital NHS Foundation Trust
  • York Teaching Hospital NHS Foundation Trust

Your commissioning area

Select a CCG
  • Airedale, Wharfdale and Craven
  • Ashford
  • Aylesbury Vale
  • Barking and Dagenham
  • Barnet
  • Barnsley
  • Basildon and Brentwood
  • Bassetlaw
  • Bath and North East Somerset
  • Bedfordshire
  • Bexley
  • Birmingham Crosscity
  • Birmingham South and Central
  • Blackburn with Darwen
  • Blackpool
  • Bolton
  • Bracknell and Ascot
  • Bradford City
  • Bradford Districts
  • Brent
  • Brighton and Hove
  • Bristol
  • Bromley
  • Bury
  • Calderdale
  • Cambridgeshire and Peterborough
  • Camden
  • Cannock Chase
  • Canterbury and Coastal
  • Castle Point and Rochford
  • Central London (Westminster)
  • Central Manchester
  • Chiltern
  • Chorley and South Ribble
  • City and Hackney
  • Coastal West Sussex
  • Corby
  • Coventry and Rugby
  • Crawley
  • Croydon
  • Cumbria
  • Darlington
  • Dartford, Gravesham and Swanley
  • Doncaster
  • Dorset
  • Dudley
  • Durham Dales, Easington and Sedgefield
  • Ealing
  • East Lancashire
  • East Leicestershire and Rutland
  • East Riding of Yorkshire
  • East Staffordshire
  • East Surrey
  • East and North Hertfordshire
  • Eastbourne, Hailsham and Seaford
  • Eastern Cheshire
  • Enfield
  • Erewash
  • Fareham and Gosport
  • Fylde & Wyre
  • Gateshead
  • Gloucestershire
  • Great Yarmouth and Waveney
  • Greater Huddersfield
  • Greater Preston
  • Greenwich
  • Guildford and Waverley
  • Halton
  • Hambleton, Richmondshire and Whitby
  • Hammersmith and Fulham
  • Hardwick
  • Haringey
  • Harrogate and Rural District
  • Harrow
  • Hartlepool and Stockton-On-Tees
  • Hastings and Rother
  • Havering
  • Herefordshire
  • Herts Valleys
  • Heywood, Middleton and Rochdale
  • High Weald Lewes Havens
  • Hillingdon
  • Horsham and Mid Sussex
  • Hounslow
  • Hull
  • Ipswich and East Suffolk
  • Isle of Wight
  • Islington
  • Kernow
  • Kingston
  • Knowsley
  • Lambeth
  • Lancashire North
  • Leeds North
  • Leeds South and East
  • Leeds West
  • Leicester City
  • Lewisham
  • Lincolnshire East
  • Lincolnshire West
  • Liverpool
  • Luton
  • Mansfield and Ashfield
  • Medway
  • Merton
  • Mid Essex
  • Milton Keynes
  • Nene
  • Newark & Sherwood
  • Newbury and District
  • Newcastle North and East
  • Newcastle West
  • Newham
  • North & West Reading
  • North Derbyshire
  • North Durham
  • North East Essex
  • North East Hampshire and Farnham
  • North East Lincolnshire
  • North Hampshire
  • North Kirklees
  • North Lincolnshire
  • North Manchester
  • North Norfolk
  • North Somerset
  • North Staffordshire
  • North Tyneside
  • North West Surrey
  • North, East, West Devon
  • Northumberland
  • Norwich
  • Nottingham City
  • Nottingham North and East
  • Nottingham West
  • Oldham
  • Oxfordshire
  • Portsmouth
  • Redbridge
  • Redditch and Bromsgrove
  • Richmond
  • Rotherham
  • Rushcliffe
  • Salford
  • Sandwell and West Birmingham
  • Scarborough and Ryedale
  • Sheffield
  • Shropshire
  • Slough
  • Solihull
  • Somerset
  • South Cheshire
  • South Devon and Torbay
  • South East Staffs and Seisdon Peninsular
  • South Eastern Hampshire
  • South Gloucestershire
  • South Kent Coast
  • South Lincolnshire
  • South Manchester
  • South Norfolk
  • South Reading
  • South Sefton
  • South Tees
  • South Tyneside
  • South Warwickshire
  • South West Lincolnshire
  • South Worcestershire
  • Southampton
  • Southend
  • Southern Derbyshire
  • Southport and Formby
  • Southwark
  • St Helens
  • Stafford and Surrounds
  • Stockport
  • Stoke on Trent
  • Sunderland
  • Surrey Downs
  • Surrey Heath
  • Sutton
  • Swale
  • Swindon
  • Tameside and Glossop
  • Telford and Wrekin
  • Thanet
  • Thurrock
  • Tower Hamlets
  • Trafford
  • Vale Royal
  • Vale of York
  • Wakefield
  • Walsall
  • Waltham Forest
  • Wandsworth
  • Warrington
  • Warwickshire North
  • West Cheshire
  • West Essex
  • West Hampshire
  • West Kent
  • West Lancashire
  • West Leicestershire
  • West London (K&C & QPP)
  • West Norfolk
  • West Suffolk
  • Wigan Borough
  • Wiltshire
  • Windsor, Ascot and Maidenhead
  • Wirral
  • Wokingham
  • Wolverhampton
  • Wyre Forest

Mortality Analysis

The white bars represent 99.8% control limits.

Control limits tell us the range of values which are consistent with random or chance variation.

Data points falling above the upper control limit are said to be significantly ‘higher than expected’, data points falling below the lower control limit are said to be significantly ‘lower than expected’, otherwise ‘within expected range’.

200
180
160
140
120
100
80
60
40
20
0
SHMI Deaths in hospital or within 30 days of discharge
0
HSMR Deaths in hospital for conditions which cause most deaths
0
HSMR (100) Deaths in hospital — all conditions
0
HSMR (3) Deaths in hospital for conditions which cause most deaths — 3 year period
0
Deaths after surgery Patients who died after an operation possibly went wrong
0
2.0
1.8
1.6
1.4
1.2
1.0
0.8
0.6
0.4
0.2
0.0
Deaths in low-risk conditions Patients who died with a condition with a low immediate risk of death (per 1000)
0
Data not available
50
45
40
35
30
25
20
15
10
5
0
Palliative care coding rate Numbers of patients who died while receiving end of life care
0
150
140
130
120
110
100
90
80
70
60
50
Acute HSMR Deaths in hospital (HSMR) excluding community patients
0
Data not available

Site-level HSMR (Deaths at each hospital site)

150
140
130
120
110
100
90
80
70
60
50
Loading data …

Commissioning Analysis

View our methodology for selecting example CCGs that perform poorly or well.

Select an indicator
  • Rate of emergency admissions to hospital adjusted for population (SAR)
  • The % of emergency admissions for people over 75 that are due to a urinary infection
  • The % of diabetics in the area who have an emergency admission
  • The % of people with respiratory problems in the area who have an emergency admission
  • Number of emergency admissions
  • Number of avoidable emergency admissions
  • Number of emergency admissions for people with diabetes
  • Number of emergency admissions for people with respiratory problems
  • Number of avoidable emergency admissions for people over 75 with a urinary infection
  • % change since 2002 of effective/less effective planned operations
  • Number of effective planned operations where alternatives to operating should be tried first
  • Number of effective planned operations where consideration should be given to the benefits to the patients
  • Number of less effective planned operations where the benefit is small
  • Number of planned hip replacements
  • Number of planned knee replacements
  • Number of planned cataract operations
Better than expected
Within expected range
Worse than expected
33.3
66.6
Trust rate: 50
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012

Distribution

Weekend Working Analysis

Select an indicator
  • Deaths in hospital following emergency admissions (Emergency HSMR)
  • Deaths in hospital following emergency admissions for patients with cancers
  • Deaths in hospital following emergency admissions excluding patients with cancers
  • Deaths for patients receiving a planned operation on a Friday
  • Emergency readmissions to hospital when patients were first discharged on a weekend
  • Emergency readmissions to hospital when patients were first admitted on a weekend
  • Not repairing broken hips within two days
  • Not repairing broken hips within two days — Friday to Saturday compared with Sunday to Thursday
  • Repair of fractures on the day of admission
  • Emergency MRI scans on the day of admission
  • Emergency endoscopies on the day of admission

Better than expected
Within expected range
Worse than expected
33.3
66.6
Trust rate: 50

The white bars represent the confidence interval around the trust ratio. The blue bar represents the confidence interval around the England ratio.

If the range of the confidence interval around a trust ratio overlaps the confidence interval for the England ratio we can be 99.8% confident that the ratio is ‘within the expected range’. If the upper confidence interval for a trust ratio is below the lower confidence interval of the England ratio, the trust ratio is said to be ‘lower than expected’. If the lower confidence interval is above the upper confidence interval of the England ratio, the trust ratio is said to be ‘higher than expected’.

Better than expected
Within expected range
Worse than expected
33.3
66.6
Trust rate: 50
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